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Arthritis

Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, they now have evidence that the bone underneath the cartilage is also a key player and exacerbates the damage. In a proof-of-concept experiment, they found that blocking the action of a critical bone regulation protein in mice halts progression of the disease.

The prevailing theory on the development of OA focuses on joint cartilage, suggesting that unstable mechanical pressure on the joints leads to more and more harm to the cartilage - and pain to the patient - until the only treatment option left is total knee or hip replacement. The new theory, reported May 19 in Nature Medicine, suggests that initial harm to the cartilage causes the bone underneath it to behave improperly by building surplus bone. The extra bone stretches the cartilage above and speeds its decline.

“If there is something wrong with the leg of your chair and you try to fix it by replacing the cushion, you haven’t solved the problem,” says Xu Cao, Ph.D., director of the Center for Musculoskeletal Research in the Department of Orthopaedic Surgery at the Johns Hopkins University School of Medicine. “We think that the problem in OA is not just the cartilage ‘cushion,’ but the bone underneath,” he adds.

Joints are formed at the intersection of two bones. To prevent the grinding and wearing down of the ends of the bones, they are capped with a thin layer of cartilage, which not only provides a smooth surface for joint rotation but also absorbs some of the weight and mechanical strain placed on the joint. The degeneration of this protective layer causes extreme pain leading to limited mobility.

Patients with rheumatoid arthritis (RA) are receiving the recommended cancer screening tests, but the recommendations may not be adequate for these patients, researchers reported.

Compared with controls, women with RA were more likely to have had a Pap smear (HR 1.21, 95% CI 1.17 to 1.24), a mammogram (HR 1.49, 95% CI 1.45 to 1.53), and a colonoscopy (HR 1.69, 95% CI 1.61 to 1.77), according to Seoyoung C. Kim, MD, and colleagues from Brigham and Women’s Hospital in Boston.

However, “given the increased risk of some cancers in RA and concerns in the association between various types of RA treatment and malignancy, it may be worth investigating the effectiveness of current cancer screening guidelines in patients with RA and in subgroups on specific treatments,” Kim and colleagues wrote online in Arthritis & Rheumatism.

According to a study presented today at EULAR 2012, the Annual Congress of the European League Against Rheumatism, patients with psoriatic arthritis (PsA) who are starting anti-tumour necrosis factor (anti-TNF) treatment and adhere to a hypocaloric diet have a significantly greater chance of achieving minimal disease activity (MDA, an important measure of disease activity) at six months compared to those on a standard diet.

The results of an Italian study of 138 obese PsA patients demonstrated that those who achieved a ≥10% weight loss following a calorie restricted diet, were more likely to achieve MDA, compared to patients on a standard diet (p=0.001). These patients also had significantly higher changes in erythrocyte sedimentation rate (ESR, a test that indirectly measures the amount of inflammation in the body), and c-reactive protein (CRP, a marker of systemic inflammation, a recently identified predictor of structural damage progression) compared to patients on a standard diet.

“A study presented at the 2009 meeting of the Society for Investigative Dermatology, alerted us to the fact that patients with psoriatic arthritis have an increased prevalence of obesity, however our study has gone beyond that, assessing whether diet is able to improve the achievement of minimal disease activity in obese patients treated with anti-TNFs” said Dr. Dario Di Minno from the University of Naples Federico II, Italy and lead author of the study. “The results of our study suggest that obese patients with psoriatic arthritis who stick to a hypocaloric diet have a greater chance of achieving treatment goals.”

Adding another incentive to exercise, scientists at Duke University Medical Center have found that physical activity improves arthritis symptoms even among obese mice that continue to chow down on a high-fat diet.

The insight suggests that excess weight alone isn’t what causes the aches and pains of osteoarthritis, despite the long-held notion that carrying extra pounds strains the joints and leads to the inflammatory condition.

Published Sept. 27 online in the journal Arthritis & Rheumatism, the findings are now being tested in people.

“What’s surprising is that exercise, without substantial weight loss, can be beneficial to the joints,” said Farshid Guilak, Ph.D., professor of orthopaedic surgery at Duke and senior author of the study. “Ideally, it would be best to be fit and lose a little weight, but this shows that exercise alone can improve the health of your joints.”

Only three percent (n=181) of patients in the study cohort receiving anti-tumour necrosis factor agents (anti-TNFs) for treatment of their arthritis developed a first cancer within nine years and overall risk was not dependent on the type of arthritis.

The nine year follow-up study conducted at Gentofte University Hospital, Denmark demonstrated that relative risk ((RR)=1.03 (95%confidence interval 0.82-1.30)) was not increased in patients treated with anti-TNFs compared to patients who had never taken anti-TNFs during 23,965 person-years follow-up. Overall cancer risk was not dependent on the type of arthritis including rheumatoid arthritis (RA) (n=3,496) (RR=1.05, 95% CI 0.82-1.34), psoriatic arthritis (PsA) (n=670) (RR=1.98, 95% CI 0.24-16.18) or other arthritis (n=499) (RR=0.79 95% CI 0.08-8.33).

“Some studies have suggested that taking anti-TNFs may increase an individual’s risk of cancer however this study provides long term evidence that an overall risk of cancer is not associated with this group of treatments”, said Dr. PhD, Lene Dreyer from the Department of Rheumatology at Gentofte University Hospital. “TNF is a small signalling molecule called a cytokine and is able to inhibit the development of tumours by interfering with signalling pathways. Therefore drugs targeting TNF can influence the development of tumours, although the extent of this impact remains unclear.”

A recent trial of rituximab in combination with a tumor necrosis factor (TNF) inhibitor and methotrexate (MTX) in patients with active rheumatoid arthritis (RA) found the safety profile to be consistent with other RA trials with TNF inhibitors. While the trial reported no new safety risks, clear evidence of an efficacy advantage in RA patients receiving the combination therapy was not observed in this study sample. Results of the trial are published in the March issue of Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology.

The National Arthritis Data Workgroup estimates that 1.3 million U.S. adults have RA which is characterized by systemic joint inflammation that often leads to joint damage, functional impairment and significant disability. While MTX is successfully used to treat many RA patients, the severity of the disease in some patient populations requires the use of additional disease-modifying antirheumatic drugs (DMARDs). A specific group of biologic DMARDs, called tumor necrosis factor (TNF) inhibitors and includes such therapies as etanercept and adalimumab, block the immune system response, and have been shown to be safe and effective in clinical trials.

Prior studies, however, have found that up to 40% of RA patients exhibit an inadequate response, intolerance, or inadequate slowing of the rate of joint damage with biologic therapies, and require additional treatment options. “Our objective was to assess the safety of the biologic DMARD, rituximab, in combination with a TNF inhibitor and MTX in patients with active RA,” said lead study author Maria Greenwald, M.D., from Desert Medical Advances in California. This was a small exploratory study to evaluate safety with this combination due to the prolonged effect of rituximab, and the fact that RA patients may switch to an alternate biologic such as a TNF inhibitor before the effects of rituximab may have resolved.

A new study found that patients with osteoarthritis (OA) of the knee who also have pain in other joints were more likely to experience greater knee pain. Specifically, pain in the lower back as well as foot pain and elbow pain on the same side as the affected knee were associated with more severe knee pain. Full details appear in the December issue of Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.

Knee OA is the leading cause of disability in the U.S., with nearly 4.3 million adults over age 60 having the symptomatic form of the disease according to the Centers for Disease Control and Prevention (CDC). A study by Helmick et al. published in Arthritis & Rheumatism reported 59 million people have low back pain, which is the most common cause of lost work time among individuals less than 45 years of age and the third most common cause among those 45 to 65 years of age.

The current study team led by Pradeep Suri, M.D., from Harvard Medical School, New England Baptist Hospital, and Spaulding Rehabilitation Hospital in Boston, Massachusetts used data provided by individuals from the Osteoarthritis Initiative - a multicenter population-based observational cohort study of knee OA.

People with newly-developed rheumatoid arthritis or undifferentiated arthritis may be able to achieve remission, with continued drug therapy, after four months of treatment with methotrexate and prednisone, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men. The new ACR/EULAR 2010 Rheumatoid Arthritis Classification Criteria are based on the recognition that undifferentiated arthritis may be the earliest clinical manifestation of RA.

Researchers recently assessed whether people with RA (which had developed less than two years before the start of the study) or undifferentiated arthritis (defined, for this study, as having arthritis in more than one joint and being considered at risk for developing RA) could achieve remission after four months of taking a combination of methotrexate and prednisone.

In the largest study to date of the Arthritis Foundation’s Tai Chi program, participants showed improvement in pain, fatigue, stiffness and sense of well-being.

Their ability to reach while maintaining balance also improved, said Leigh Callahan, PhD, the study’s lead author, associate professor in the University of North Carolina at Chapel Hill School of Medicine and a member of UNC’s Thurston Arthritis Research Center.

“Our study shows that there are significant benefits of the Tai Chi course for individuals with all types of arthritis, including fibromyalgia, rheumatoid arthritis and osteoarthritis,” Callahan said. “We found this in both rural and urban settings across a southeastern state and a northeastern state.”

Daily physical activity is essential for good health and blood glucose control in people with diabetes. But what if you also have arthritis? One in five American adults has been diagnosed with arthritis, and half of all adults with diagnosed diabetes also have arthritis. Symptoms of arthritis can make it difficult to be active. But don’t let that stop you in your efforts: Frequent physical activity can help reduce the pain and stiffness of arthritis by improving muscle strength, endurance, and flexibility. Routine exercise also increases energy levels and helps with weight control. Other benefits include lowered blood pressure, a lower risk of heart disease, and sometimes improved sleep patterns.

If you have arthritis as well as diabetes, it is important to keep your muscles as strong as possible, because the stronger the muscles and tissues are around the joints, the better they will support and protect those joints. When you don’t exercise, your muscles become weak and your bones become more brittle, which leads to a worsening of arthritis symptoms and to other health problems such as osteoporosis, the decrease in bone density that can lead to bone fractures.

About arthritis
The most common form of arthritis is osteoarthritis, in which cartilage in the joints deteriorates.

Researchers from the Norwegian University of Science and Technology have found a link between obesity in women and fibromyalgia, an incurable disease that causes chronic pain. The study found an increased risk for fibromyalgia in women who lead a sedentary lifestyle and have a higher body mass index (BMI).

Fibromyalgia (FM) is diagnosed when a patient suffers from chronic pain that lasts for more than three months, tender joints, headaches, unexplained fatigue and mood disturbances. Although the exact cause of FM is unknown, the risk for developing FM increases with age and is more common in women than in men.

Overweight and obese women—especially those who do not exercise at all or exercise for less than an hour a week—are at higher risk for developing the widespread pain disorder fibromyalgia, according to new research in the May issue of Arthritis Care & Research.

“Being overweight or obese was associated with an increased risk of fibromyalgia, especially among women who also reported low levels of leisure time physical exercise,” the researchers conclude. “Community-based measures aimed at reducing the incident of fibromyalgia should emphasize the importance of regular physical exercise and maintenance of normal body weight.”

Fibromyalgia affects an estimated 10 million people in the U.S. and is marked by widespread pain and tender points along the body, extreme fatigue, sleep problems, depression, and problems with cognition, according to the National Fibromyalgia Association. Other suspected risk factors for fibromyalgia include stressful or traumatic events such as an automobile accident, family history, or the presence of rheumatic diseases such as lupus.

Some studies have suggested that moderate drinkers have a lower risk of developing rheumatoid arthritis, and now new findings link the habit to a slower progression of the joint disease.

In a study that followed 2,900 adults with rheumatoid arthritis (RA), Swiss researchers found that light-to-moderate drinkers showed slower progression in their joint damage compared with non-drinkers. Heavy drinkers, on the other hand, showed the greatest progression.

The findings, reported in the journal Arthritis & Rheumatism, are based on X-ray evidence of patients’ joint damage and its progression over an average of four years.

Higher levels of obesity and inactivity, especially among women, explain why arthritis is more common in the United States than in Canada, according to a new study.

Researchers at the Toronto Western Research Institute analyzed 2002-03 data from both countries and found that the prevalence of arthritis in the United States was 18.7% and the prevalence of arthritis-attributable activity limitations (AAL) was 9.6%. In Canada, the rates were 16.8% and 7.7%, respectively.

Women in the United States had a higher prevalence of arthritis (23.3%) and AAL (13%) than Canadian women (19.6% and 9.2%, respectively). Men in both countries had similar rates of arthritis (14%) and AAL (6%).